Free 2017 RVU Calculator

Welcome to the free 2017 RBRVS Calculator.

Important update: there are some considerable updates to the RBRVS data this year, especially in the GPCI figures!  More details to follow this week.

As you may know, the AMA won’t let anyone provide a free RVU calculator that includes CPT codes due to their CPT copyrights. In an abundance of caution and, because in our unhappy experience, the AMA interprets its rights (in our opinion) overly broadly, we created this tool for those of you who have a CPT license that allows for a use such as this. In theory, that should mean any practice that submits insurance claims.

To make a long story short, you can use this spreadsheet with the data that you can download from CMS to make a fairly sophisticated RVU calculator and payment analysis in about 5 minutes. This will allow you to fairly set your prices, analyze a payer contract, or double-check your expected payments. It also lets you perform a lot of other analysis tricks that the cool kids can figure out.

What does it do, technically? It allows you to choose your CMS-driven location, set a Medicare Multiplier, and then, on a code-by-code basis, determine your pricing level. If you then take the time to include your code volume and pricing, it will determine your practice’s FACF (i.e., how much you charge, on average, relative to Medicare). If you then provide your payment information, it will compare them to the Medicare fee schedule for you.

As of this writing, I have created an LibreOffice version. I now offer 2 Excel files (one original Excel, and one newer), but I need testers. I don’t trust Excel. Someone tell me if it’s OK!


How does it work?

  1. Download one of the above spreadsheets.
  2. Head to CMS and download the latest 2017 RVU zip file. This link brings you to the January 2017release; be on the look out for newer versions. You have to agree to the license and usage rules from CMS, of course.
  3. Extract the PPRRVU17_V1102.xlsx file from the zip file. Note that the actual file name will change based on version of the RVU data file you download. You are essentially looking for a file that begins with “PPRVU,” has the number 17, and ends in .xlsx and is larger than 2MB. It will have just under 17,000 CPT codes in it.
  4. Cut and paste the entire page of data from the PPRRVU17_V1102.xlsx file into the tab marked “PPRRVU17_V1102.xlsx″ in the RVU Calculator spreadsheet. Don’t panic if it seems to freeze for a minute, it’s a lot of data.
  5. Go back to the first tab. Choose your locality with the pulldown menu. Pick a Medicare Multiplier. Then, enter some CPT codes in column A. Gasp in amazement.
  6. Put some unit volumes, prices, and payments in and watch what happens. Any field marked in a light blue-gray is a place where you can enter info.

I’d love for some guinea pigs to try this out and tell me what doesn’t work. PCC clients, natch, can do this already with our reports, so I want to hear from the rest of you :-)

4 replies
  1. William A. Sanders
    William A. Sanders says:

    Thanks for the update, Chip. I used the new Excel version, and it worked perfectly. I do have a question about how to use this information the best. We use PCC, and one of the biggest “hits” we take in the Practice Vital Dashboard is that our pricing is low. Last year, I used this spreadsheet to take to my partners in order to discuss raising prices. However, their comment was that it wasn’t necessary because we weren’t getting paid what we were charging anyway. Why raise a cost to $120 from $100 if we were only getting paid $80 anyway? We ended up just using the tool to see where our payments were close or equal to our charges, and raised only those. Do you have any advice for this, or does this simply mean we need to negotiate with the payers to get our reimbursement up?

    Reply
    • Chip Hart
      Chip Hart says:

      Great question.

      First, as a PCC client, you should know that we have some easy reports
      that generate all this data for you a lot easier. The spreadsheet is
      cool and all, but it’s really designed for practices who don’t already
      have software to do this. Ping me off-line and I’ll show you how to
      get the same information without having to use the spreadsheet!

      Second, this is a great question and one I get often when I lecture
      about setting prices. There are many reasons why you want to price
      things properly. No single one of them will be entirely compelling,
      I suspect, but the totality of their weight should be important to your
      partners:

      • Increasing your prices when you are paid equally or
        or close to your charges is exactly what the insurance companies
        want you to do. Why? Because if you go pull your contracts, I bet
        you will see that they often say something like, “We will pay you our
        fee schedule or 80% of your charges, whichever is lower…” A $5
        writeoff usually indicates that you are leaving money on the table.

      • Every time you submit a claim that averages, say, 120% of
        Medicare to the insurance, you continue to build a “profile” that
        says, “Pediatricians are cheap, especially this office.” What do
        other specialties charge – 250-400% as a rule. Why should
        pediatricians accept LESS money for the SAME procedures as another
        specialty? No, those other doctors have learned that _the practices
        who charge the most, generate the most revenue_.

      • EVERY practice I have ever worked with is imperfect at setting
        prices. The very process of going through all of the procedures and
        setting them to a consistent price ensures that you don’t have
        something going out on claims that loses money. I’ve seen it too many
        times to count.

      I could go on, but this is a start. I’d love to know what you think.

      Reply

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